WMA Statement on Ageing

Adopted by the 67^th WMA General Assembly, Taipei, Taiwan, October 2016
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

The world is experiencing an unprecedented increase in life expectancy. Over the last century, some 30 years have been added to global average life expectancy at birth (LEB). However, these improvements are very variable; many of the poorest communities in all countries and a larger percentage of the population in the poorest countries have gained less in terms of life expectancy over this period of time.

The increase in longevity has coincided with a decreasing number of children, adolescents and younger adults as some countries experience total fertility rates below replacement level, raising the average age in these countries.

The challenges of ageing, particularly in developing countries, are complicated by the fact that essential resources and infrastructure are seldom in place. In most cases, populations are ageing more rapidly than resources and infrastructure are being developed.

Unpaid carers, in particular for older people requiring long-term and/or palliative care, should be supported and encouraged to balance their caring role with their professional and social lives, while maintaining their own health and well-being.

The World Health Organization (WHO) defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”[1]. The term “functional ability” is used to describe “the capabilities that enable all people to be and do what they have reason to value”. Relatedly, AGE Platform Europe defines age equity as “an inclusive society, based on well-being for all, solidarity between generations and full entitlement to enjoy life, participate in and contribute to society. At the same time, each person’s rights and responsibilities throughout their life course have to be fully respected”[2]. Healthy ageing presupposes a life course perspective as the social, behavioral, personal, economical and environment determinants that influence healthy ageing operate throughout the life course of an individual.

It is essential to rethink the way in which society and physicians value age and to promote an active role for the older people in the community without discrimination, as outlined in the WMA Declaration on discrimination against Elderly Individuals within Healthcare Settings.

GENERAL PRINCIPLES

Medical Expenses Associated with Ageing

1. There is strong evidence that chronic diseases, rather than age per se, increase the use (and costs) of health services. However, chronic conditions and disabilities become more prevalent with advancing age. Therefore, health care use and spending rise in tandem with age.
2. In many countries, health care spending for older persons has increased over the years as more interventions and new technologies have become available for problems common in older age.
3. Awareness should be raised about the potential unintended impact of overtreatment as some investigative or treatment options do not necessarily contribute beneficially to the patient’s overall health.

Effect of Ageing on Health Systems

4. Health care systems face two major challenges as longevity increases: preventing chronic disease and disability, and delivering high quality and cost-effective care that is appropriate for individuals of all ages. In less developed regions the disease burden in old age is higher than in more developed regions.

Special Health Care Considerations

5. Compared to the general population, older adults are more likely to experience social isolation and loneliness. These risk factors contribute to chronic diseases common in older adults, such as cognitive decline and dementia, by adversely affecting their physical and mental health. Approximately 1 in 4 older people experience social isolation, and research proves that the impact of social isolation and loneliness on mortality is similar to that of smoking, obesity, and physical inactivity[3].
6. The leading causes of disability worldwide are cardiovascular disease, cancer, chronic respiratory disease, musculoskeletal disorders, and neurological and mental diseases, including dementia. Some common conditions in older age are especially disabling and benefit from early detection and management.
7. Chronic diseases, particularly cardiovascular disease, diabetes, chronic obstructive pulmonary disease and many types of cancer, are common among older people and include diseases preventable through healthy behaviors and/or lifestyle interventions, effective preventive health services, and policy interventions.
8. While research may eventually lead to effective disability prevention or treatment, early management is key to controlling disability and/or maintaining quality of life.
9. Older persons may be more vulnerable to the effects of accidents within and outside the home. As older people continue to work, these risks must be assessed and managed. Those who suffer injuries may have their recovery complicated by other medical vulnerabilities and comorbidities.

Considerations for Health Care Policy Makers and Professionals

10. At a societal level, achieving age equity requires action across multiple sectors. For example, design solutions can help make environments more age-friendly and often benefit the general population.
11. Similarly, achieving healthy ageing also often requires a variety of professionals working as an articulated team.
12. Older people come from diverse backgrounds. The policies, systems, environments, care, and medical education and training may need to be tailored to optimally care for every individual.

Continuum of Care

13. A comprehensive continuum of health services needs to be adopted urgently as populations age. It should include health promotion, disease prevention, curative treatments, rehabilitation, management and prevention of decline, and palliative care.
14. Different types of health care providers should be utilized to offer these services, from self and family/informal care – sometimes in a voluntary capacity – to community-based providers and institutions.

Establishing Optimal Health Care Systems

15. Universal Health Coverage should be provided to all, including older people.
16. The vast majority of health problems can and should be dealt with at the community level. In order to provide optimal community care and ensure care coordination over time, it is critical to strengthen Primary Health Care (PHC) within health systems, by addressing workforce shortages and by planning and ensuring adequate financial resources and equipment provision in PHC facilities, as outlined in the WMA Statement on Primary Health Care. This includes empowering community health workers and interdisciplinary care teams to deliver age-friendly services, particularly in resource-limited settings.
17. In order to strengthen PHC to promote healthy ageing, WHO advanced evidence-based principles for age-friendly PHC in three areas which should be considered: information/education/communication/ training, health care management systems and the physical environment of PHC centers.
18. The health sector should encourage health care systems to support and facilitate access to all such dimensions of care to individuals as they age.
19. Health systems must adapt to ageing in order to guarantee their financial sustainability and avoid imbalances.
20. Health systems and communities should implement evidence-based interventions such as social prescribing, community engagement programs, and digital inclusion initiatives to reduce social isolation and its health impacts.
21. Preventative consultations should be encouraged, particularly to identify age-related risks and preserve independence.
22. Communication during winter vaccination campaigns targeting older people must be strengthened. Access to vaccination must be facilitated and encouraged.

Specificities of Health Care

23. Many formal systems of health care have been developed with an emphasis on “acute or catastrophic care” of a much younger population, often focused on communicable diseases and/or injuries. Health systems should emphasise other needs, especially prevention, chronic diseases management, cognitive decline, palliative care and long-term care when treating older people. While acute care services are essential for people of all ages, they are not focused on keeping people healthy or providing the ongoing support and care required to manage geriatric conditions. A geriatric evaluation and handling of elderly patients should be available in every acute care facility.
24. Medical conditions in older age often occur simultaneously with social problems and both need to be considered by health professionals when providing health care. Physicians, particularly specialists, should bear in mind that older patients may have other concurrent chronic diseases or comorbidities that interact with each other and that their treatment should not lead to inadvertent and preventable induction of complications.
25. When initiating a pharmacologic treatment for chronic disease in an older patient, the principles of geriatric pharmacology should be observed.
26. Older patients´ right to self-determination must be respected. If the patient cannot decide for him/herself, due to memory and cognitive problems, physicians treating older patients should actively communicate with the family, unpaid carers, and frequently with formal caretakers, to provide support and educate them about the patient’s health condition and medication administration.
27. When considering different therapeutic options, physicians should always seek to find out the wishes of the patient and recognise that, for some patients, quality of life will be more important than the potential results of more aggressive treatment options.
28. Development of appropriate digital and technical solutions and tools that can improve care, and access to care, for older people should be promoted. International cooperation and technical assistance should be mobilized to support developing countries in building sustainable infrastructure and services that address the needs of ageing populations.

Education and Training for Physicians

29. All physicians should be appropriately educated and trained to diagnose and treat the health problems of older people, which means integrating ageing into medical curricula., including geriatrics, gerontology, and palliative care. In particular, general practitioners should have access to information and undergo education and training to identify and prevent polypharmacy and potentially adverse drugs interactions and be educated in geriatric pharmacological therapy.
30. Secondary health care for older people should be provided as necessary. It should be holistic, including taking into consideration psychosocial as well as environmental aspects, in line with the approach of comprehensive geriatric assessment. As outlined in the WMA Declaration of Hong Kong, physicians should also be aware of the risks of abuse and measures to be taken when abuse is identified or suspected.
31. Continuing medical education on topics relevant to the ageing patient should be emphasised in order to help physicians adequately diagnose, treat, and manage the complexities of caring for an ageing population.

[1] https://www.who.int/news-room/questions-and-answers/item/healthy-ageing-and-functional-ability
[2] A society for all ages (AGE Platform Europe)
[3] Social Isolation and Loneliness (who.int) / New details about loneliness and dementia risk – Harvard Health